Low testosterone concentration associated with men’s COVID severity
Low testosterone concentrations in men with COVID-19 are associated with a greater likelihood of COVID-19 infection severity, artificial ventilation or intensive care unit (ICU) treatment, and death, according to a study yesterday in JAMA Network Open.
The researchers looked at the hormone levels in an observational cohort of 152 men and women with symptomatic COVID-19 at the Barnes-Jewish Hospital in St. Louis from March to May 2020 (mean age, 63 years). Of the 143 who were admitted, hormones were also measured at days 3, 7, 14, and 28 as long as they were still hospitalized.
Women had no correlation between COVID-19 outcomes and hormone levels of testosterone, estradiol (a form of estrogen), or growth hormone insulin growth factor 1 (IGF-1). Men with low testosterone concentrations, however, had an inverse association with the odds of severe COVID-19 (odds ratio [OR], 0.11), ICU admittance (OR, 0.15), artificial ventilator use (OR, 0.29), and a statistically insignificant link with mortality.
At admission, testosterone concentrations were 64.9% lower in severe male patients versus mild male patients (median 53 nanograms per deciliter [ng/dL]), and the gap only increased at days 3 and 7 post-hospitalization (82.9%, with 19 vs 111 ng/dL, and 84.1%, 20 vs 126 ng/dL, respectively). The study’s reference testosterone concentration level is defined as 250 ng/dL, although the researchers note that they didn’t have pre-infection testosterone levels for the patients. Additionally, the data showed that lower testosterone concentrations in the male COVID-19 patients were linked with higher inflammation and the body’s increased ability to detect and use the hormone.
Because of the study’s observational format, the researchers say they do not know if lower testosterone levels are a causal factor or simply a biomarker indicator. They also note that while this association was found independent of COVID risk factors such as age, body mass index, comorbidities, and race, low testosterone concentrations in general are associated with increasing age, obesity, and diabetes.
“During the pandemic, there has been a prevailing notion that testosterone is bad,” said senior author Abhinav Diwan, MD, in a Washington University press release. “But we found the opposite in men. … And if testosterone levels dropped further during hospitalization, the risk increased.”
May 25 JAMA Netw Open study
May 25 WashU press release
Long COVID affects families, not just survivors, study notes
Long haul COVID-19 affects not only the survivor but also their partners and close family, according to a UK study yesterday in BMJ Open.
In a self-reported survey from May 30 to Aug 30, 2020, 735 long-haul COVID-19 survivors and 735 of their partners and close family members were surveyed. Most survivors (86.6%) still had symptoms 4 weeks post-diagnosis, and 63.5% still had symptoms after 12 weeks. Their quality of life was measured primarily on the EuroQol group five dimensions three level (EQ-5D-3L) scale, which rates five areas from 1 to 3, with 3 being the worst. The average score was 8.65 out of 15.
The most affected outcome was doing usual activities (2.06), and most frequently reported ailments were pain and discomfort (81.1%), effects on usual activities (79.5%), and anxiety and depression (68.7%).
As for their partners and close family members, they answered questions on the Family Reported Outcome Measure (FROM-16) scale and had an average score of 15 out of 32. FROM-16 measures 16 areas, each on a scale of 0 to 2, with 2 being the worst; the worst outcome was for feeling worried, which had a value of 1.46.
Most said their loved ones’ lingering symptoms caused them to feel worried (93.6%), affected family activities (83.3%), and made them feel frustrated (81.7%) or sad (78.4%). Many also said their sleep (68.9%) and sex life (68.1%) were affected, too.
“Our study reveals a domino effect from the COVID patient themselves through to all those closest to them,” said lead author Rubina Shah, MSc, MPH, in a Cardiff University press release. “The impact of COVID can be profound and long lasting; there needs to be a holistic support system that is sensitive to the needs of both survivors and their families to help ease this burden.”
Overall, 76.6% of the survivors were women, and the mean age was 48 years. Comparatively, their partners and family members had a mean age of 47, and 33.5% were women. About half (50.6%) of the responses came from Europe, and 38.5% came from North America.
May 25 BMJ Open study
May 25 Cardiff press release
Health worker survey shows concerns, fear during COVID-19
In a May to June 2020 survey, about 1,200 US health workers relayed frustrations with unsafe and devaluing working conditions, according to a George Washington University press release.
Most respondents worked in a hospital setting, and many were nurses.
While some said they had employers who were trying their best to provide adequate personal protective equipment (PPE), more said that they felt unsafe because of the lack of it, and many reported retaliation or bullying in response to any workplace concern. Additionally, the constantly changing guidelines from their employer or federal agencies left them frustrated.
Among the health workers’ suggestions for moving forward were: an increase in the national stockpile of PPE, better communication and evidence-based worker protection policies, and improved labor rights such as time off, mental health care, and a zero tolerance policy for bullying or retaliation.
“This survey was anonymous and health care workers said they appreciated having a safe space to share their concerns,” lead author Brenda M. Trejo Rosas, MPH, said. “Our report exposes the impact of power dynamics in the work environment.”
May 25 GWU press release